Published By: TruBridge
Published Date: Apr 01, 2015
Rolling Plains Memorial Hospital achieved a substantial $438,000 reimbursement improvement in just 3 months by taking advantage of TruBridge’s Clinical Documentation Improvement (CDI) Training. Rolling Plains Memorial Hospital is an 85 bed community hospital located in Sweetwater, TX with annual revenue of $42 million. As the executives at this facility noticed a discrepancy in patients’ charts and the level of care the patients received, they knew something needed to change. TruBridge was able to make a dramatic difference in clinical documentation and capture the earned reimbursements.
Creating a successful patient experience strategy is a long-term investment in planning, surveying, training, and technology. Healthcare organizations hope these efforts will pay off at the very least with a growing base of loyal patients, better care quality, and stable reimbursement. And then there are those organizations that are turning patient experience into a movement. What’s their endgame? They intend to build state-of-the-art service-oriented cultures that rival other industries, and they are doing it through data analytics, unique communication programs, radical cultural shifts, and consumer-centric technologies.
From Ebola preparedness to leading large-scale changes, today’s master’s degree programs are producing leaders eager to tackle this generation’s most pressing challenges.
Rahul Anand, MD, is chief epidemiologist at Middlesex Hospital in Middletown, Connecticut, where he heads up all infectious disease prevention activities for the nonprofit integrated delivery network, from Ebola preparedness to hand washing. He’s also adjunct assistant professor in the department of medicine at the University of Utah, where he worked full time prior to moving to the East Coast. On top of that, he is one-third of the way through an MBA program at the University of Massachusetts Isenberg School of Management. It will take him another two years to finish the online program.
Alan Manning has an intimate view of what it takes to provide an outstanding patient experience, not only because he has been COO of Derby, Connecticut–based Planetree for four years, but also because he spent several months in the hospital with his critically ill daughter. That pivotal experience, while traumatic, solidified friendships with his daughter’s nurses and brought him several years later to Planetree, a nonprofit organization started in 1978 by a patient who wanted to help hospitals deliver stronger patient-centered care practices. Planetree works with 700 organizations in more than 17 countries.
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Nearly six years after passage of the Patient Protection and Affordable Care Act, the healthcare industry is in the midst of a massive retooling that is dramatically altering the way we think about cost management, strategic partnerships, and customer service.
Fee-for-service reimbursement is giving way to new models of care delivery and payment to support a system based on pay-for-value. With financial risk or payments tied to value measures (such as patient satisfaction, clinical performance, and population health), compensation and reimbursement will increasingly be tied to value-based incentives.
Healthcare reforms have prompted hospitals across the country to improve cost efficiencies wherever they can. In response, the accounts payable department of Southern Louisiana’s Ochsner Health System discovered a solution that helped improve cash management while reducing costs.
Hospital communications used to be a lot simpler. If you needed to find a doctor, you could dial 0 and the operators would connect you or send a page on your behalf. People communicated through paper charts, wrote key phone numbers on grease boards, and kept on-call schedules in binders. Some of this still happens today, but communications across healthcare have become progressively more convoluted. The use of diverse mobile devices (smartphones, tablets, pagers, Wi-Fi phones, etc.), and the rise in care complexity necessitating care team coordination mean more sophisticated communication technology is required.
Today in healthcare the communication infrastructure is the backbone in IT. New reimbursement models are amplifying the need for care coordination, and communication between multiple departments, constituencies, and workflows is required. High-performing healthcare systems are adopting enterprise communication solutions to eliminate silos of information, improve patient care during critical situations, and make the most of their IT budget.
In response to concerns raised by healthcare leaders that the absence of adjustment for socioeconomic status (SES) and race characteristics in patient populations impedes the fair comparison of hospitals on risk-standardized 30-day unplanned readmission rates, Truven Health AnalyticsTM evaluated the extent to which risk-adjusted readmission rates for acute myocardial infarction, heart failure, and pneumonia are affected by adjustments for community-level SES factors through its Community Need Index (CNI) and patient race. The study shows there is, indeed, a statistically significant effect. For more, visit truvenhealth.com/wp/readmissionpenalties.
Healthcare providers can deliver much more effective care if they have an understanding of the characteristics, attitudes, and self-reported health status of a patient’s age group. By communicating effectively and delivering care in a manner that resonates with that particular group of patients, healthcare providers can strive to achieve better outcomes and higher patient satisfaction.
Medicare spend per beneficiary (MSPB) information is a Centers for Medicare & Medicaid Services metric that reflects the average cost of an episode of care for Medicare patients. This measure is important to consider as part of a hospital’s national balanced scorecard, as it reflects executives’ efforts to transform the healthcare delivery system and manage the full continuum of care, including the prominent shift from inpatient to outpatient utilization.
The Truven Health Analytics 50 Top Cardiovascular Hospitals study identifies U.S. hospitals that have achieved the best performance on a balanced scorecard of performance measures. Based on comparisons between study winners and a peer group of similar hospitals that were not winners, winners are achieving better outcomes while operating more efficiently and at a lower cost. If all cardiovascular providers performed at the same level of this year’s winners, almost 8,000 additional lives could be saved; nearly 3,500 heart patients could be complication free; and more than $1.3 billion could be saved.
This Fact File examines trends in the detection and treatment of acute myocardial infarctions, or heart attacks, in two distinct groups:
STEMI—ST segment elevation myocardial infarction, with the ST segment referring to a specific part of an electrocardiogram tracing. In STEMI, the coronary artery is completely blocked and cardiac muscle dies.
NSTEMI—Non-ST segment elevation myocardial infarction. In NSTEMI, a coronary artery is partially blocked.
Partners HealthCare has implemented a program that helps surgeons and other clinicians easily apply best practice guidelines to a patient’s unique status. In this case study executives share the secret to boosting rates of appropriate use of high-cost procedures, and eliminating medical necessity reviews.
ICD-10 has presented monumental preparation challenges to U.S. healthcare providers, who have had to overhaul their billing departments and systems and retrain their staffs. And many may now think the heavy lifting is done, according to a recent survey of industry executives conducted by HealthLeaders Media and The SSI Group, Inc. But while providers may successfully get a bill out the door with a valid ICD-10 code, they may not be prepared for a payment delay or an actual drop in revenue when the payer sends it back for more details.
U.S. healthcare providers are venturing into the treacherous waters of value-based care, and many are starting their voyages in leaky boats, according to a recent survey of industry executives conducted by HealthLeaders Media and sponsored by RelayHealth.
Creating a state-of-the-art clinical documentation improvement (CDI) program isn’t just about boosting coding accuracy. It’s a key strategy in managing the transition from volume-based to value-based care, say healthcare leaders. That transition is a risky endeavor that is putting hospital and physician financial performance to the test. As hospitals participate in new care and business models aimed at improving value, leaders must ensure that their organizations are able to maintain reimbursement levels, effectively treat the chronically ill—especially in outpatient settings—and gather accurate data that will allow them to assess performance and segment their varying populations. While some organizations often believe they are leaving revenue on the table because of documentation and coding issues, CDI offers numerous opportunities for improving financial performance, finds a recent HealthLeaders Media survey of 149 healthcare executives at provider organizations.
For a non-profit enterprise seeking to design effective investment portfolios for its asset pools, understanding the role of each of those asset pools is a crucial first step.
The organization's goals and exposures can impact all parts of its portfolio construction process, from initial broad decisions on risk tolerance to more targeted decisions on asset-class exposures and investment vehicle preferences.
Published By: Caradigm
Published Date: Feb 16, 2015
Many organizations joined the ACO program with the idea of using it as the first step in the transition to new reimbursement models. It’s a critical time for more ACOs to achieve the milestone of shared savings in order to demonstrate the ability to lower costs for an “at-risk” population. As best practices are emerging from early participants in the ACO program, ACOs have the opportunity to evolve their strategies in order to achieve more success.